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General NPI Number Information
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NPI Number | 1750425419
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Entity Type | Individual
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Provider Name | EDDY JACQUES VINCENT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 224 NEW YORK AVE
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City | BROOKLYN
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State | NY
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Zip | 11216-4067
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Country | US
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Telephone | 718-493-6964
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Fax | 718-493-6968
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Provider Business Mailing Address
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Address Line | 224 NEW YORK AVE
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City | BROOKLYN
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State | NY
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Zip | 11216-4067
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Country | US
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Telephone | 718-493-6964
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Fax | 718-493-6968
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 133188
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License Number State | NY
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